Neurotoxicity of cyclosporine A in children with steroid-resistant nephrotic syndrome: is cytotoxic edema really an unfavorable predictor of permanent neurological damage?

  • Danica Batinić
  • Danko Milošević
  • Boris Filipović-Grčić
  • Marija Topalović-Grković
  • Nina Barišić
  • Daniel Turudić
short report

DOI: 10.1007/s00508-017-1221-z

Cite this article as:
Batinić, D., Milošević, D., Filipović-Grčić, B. et al. Wien Klin Wochenschr (2017). doi:10.1007/s00508-017-1221-z
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Summary

Background

Cyclosporine A-associated neurotoxicity has been reported mainly after organ transplantation. Only a small number of children with steroid-resistant nephrotic syndrome and cyclosporine A-associated neurotoxicity have been reported.

Patients

We report three children, aged 4, 11, and 15, with steroid-resistant nephrotic syndrome and cyclosporine A-associated neurotoxicity. In two of the patients, primary diagnosis was idiopathic nephrotic syndrome, and in one it was IgA nephropathy. Magnetic resonance with diffusion-weighted imaging, combined with quantification of apparent diffusion coefficient values, showed lesions caused by cytotoxic edema indicating irreversible brain damage. Nonetheless, the patients fully recovered clinically and radiologically after prompt discontinuation of cyclosporine A.

Conclusions

Neurotoxic effects should be suspected in any child with nephrotic syndrome treated with cyclosporine A in whom sudden neurological symptoms occur. Cytotoxic edema is a rare finding in pediatric patients. However, even in such cases with seemingly irreversible brain damage, full recovery without permanent neurological sequels is possible with prompt cyclosporine A discontinuation and supportive therapy.

Keywords

Cyclosporine A neurotoxicity Steroid-resistant nephrotic syndrome Children 

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Danica Batinić
    • 1
  • Danko Milošević
    • 1
  • Boris Filipović-Grčić
    • 1
  • Marija Topalović-Grković
    • 2
  • Nina Barišić
    • 1
  • Daniel Turudić
    • 3
  1. 1.University Zagreb School of Medicine, Department of PediatricsUniversity Hospital Center ZagrebZagrebCroatia
  2. 2.University Zagreb School of Medicine, Department of Anesthesiology and Intensive CareUniversity Hospital Center ZagrebZagrebCroatia
  3. 3.School of MedicineUniversity of ZagrebZagrebCroatia

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